Analysis of Survival of Pediatric Patients with Leukemias and Lymphomas in the Oncological Context: Epidemiological Study in the State of São Paulo, Brazil, 2000-2022

Introduction: The time taken for screening, detection and initiation of treatment is a determining factor for therapeutic management in oncology. The availability of reliable data guides decisions for public policies and evaluates compliance with these policies. Objective:To analyze the survival and outcomes of pediatric patients with leukemia and lymphoma from 2000 to 2022. Method: Epidemiological, descriptive study, with data extracted from Fundação Oncocentro do Estado de São Paulo, according to the International Classification of Childhood Cancer (ICCC). The time elapsed between the first consultation and diagnosis was evaluated, between diagnosis and the start of oncological treatment, and the survival of these patients, calculated according to the Peto-Peto test. Results: 12,030 cases were analyzed, 6,994 in males and 7,292 with leukemia. The probability of the time between consultation and diagnosis exceeds 30 days was 49.29% for leukemias and 76.31 for lymphomas, a significant result for treatment and relapses (p < 0.001) but not in relation to sex; the time between diagnosis and treatment exceeding 60 days was 38.04% for leukemias and 71.97% for lymphomas. Not undergoing treatment was significant (p < 0.001) while waiting for diagnosis after consultation for patients with leukemia and lymphomas, except surgery, chemotherapy and radiotherapy combined. Conclusion: Despite the advances, a considerable percentage of patients wait longer than expected for diagnosis and initiation of treatment, impacting their survival rates

ntrodução: O tempo no rastreio, detecção e início do tratamento é fator determinante para o manejo terapêutico em oncologia. A disponibilidade de dados confiáveis orienta decisões para políticas públicas e avalia o cumprimento dessas políticas. Objetivo: Analisar a sobrevivência e desfechos de pacientes pediátricos com leucemias e linfomas de 2000 a 2022. Método:Estudo epidemiológico, descritivo, com dados extraídos da Fundação Oncocentro do Estado de São Paulo, segundo a Classificação Internacional de Câncer na Infância. Avaliou-se o tempo decorrido entre a primeira consulta e o diagnóstico; entre o diagnóstico e o início do tratamento oncológico; e a sobrevivência desses pacientes, calculada conforme o teste Peto-Peto. Resultados: Foram analisados 12.030 casos, com prevalência no sexo masculino 6.994; 7.292 corresponderam às leucemias. A probabilidade de o tempo entre a consulta e o diagnóstico ter sido superior a 30 dias foi de 49,29% para as leucemias e de 76,31 para os linfomas, significativo para o tratamento e recidivas (p < 0,001) e não por sexo; o tempo entre o diagnóstico e tratamento, superior a 60 dias, foi de 38,04% para as leucemias e de 71,97% para os linfomas. Não realizar tratamento foi significante (p< 0,001) na espera entre a consulta e o diagnóstico para os pacientes com leucemias; o mesmo para os linfomas, exceto para a combinação de cirurgia, quimioterapia e radioterapia. Conclusão: À despeito dos avanços obtidos, uma porcentagem considerável de pacientes aguarda um tempo maior do que o esperado para o diagnóstico e o início do tratamento, repercutindo nas taxas de sobrevivência desses pacientes

Introducción: El tiempo necesario para el screening, detección e inicio del tratamiento es un factor determinante para el manejo terapéutico en oncología. La disponibilidad de datos confiables orienta las decisiones de políticas públicas y evalúa el cumplimiento de estas políticas. Objetivo:Analizar la supervivencia y desenlaces de pacientes pediátricos con leucemia y linfoma en el período de 2000 a 2022. Método: Estudio epidemiológico, descriptivo, con datos extraídos de la Fundación Oncocentro del estado de São Paulo, según la Clasificación Internacional del Cáncer Infantil. Se evaluó el tiempo transcurrido entre la primera consulta y el diagnóstico; entre el diagnóstico y el inicio del tratamiento oncológico, y la supervivencia de estos pacientes, calculada según la prueba de Peto-Peto. Resultados: Se analizaron 12 030 casos, con una prevalencia masculina de 6994; 7292 correspondieron a leucemia. La probabilidad de que el tiempo entre consulta y diagnóstico sea mayor a 30 días fue del 49,29% para leucemias y del 76,31 para linfomas, significativa para tratamiento y recaídas (p < 0,001) y no para sexo; para el tiempo entre diagnóstico y tratamiento, superior a 60 días, fue del 38,04% para las leucemias y del 71,97% para los linfomas. No recibir tratamiento fue significativo (p < 0,001) en la espera entre la consulta y el diagnóstico en pacientes con leucemia; lo mismo para los linfomas, excepto la combinación de cirugía, quimioterapia y radioterapia. Conclusión: A pesar de los avances logrados, un porcentaje considerable de pacientes espera un tiempo más de lo esperado para el diagnóstico y el inicio del tratamiento, impactando en las tasas de supervivencia de estos pacientes.

Estrategias de comunicación enfermero-paciente: propuesta de un video educativo para estudiantes de enfermería / Nurse-patient communication strategies: A proposal of an educational video for Nursing students / Estratégias de comunicação enfermeiro-paciente: proposta de um vídeo educativo para estudantes de enfermagem

Objetivo: elaborar, validar y evaluar un video educativo sobre estrategias de comunicación enfermero-paciente para estudiantes de la carrera de enfermería. Método: se trata de un estudio metodológico, con diseño longitudinal y análisis cuantitativo. El público objetivo cumplió las etapas de preproducción, producción, postproducción y evaluación del video. Resultados: cinco enfermeras evaluaron el storyboard del video y consideraron que la comprensión del tema, los tópicos abordados y el lenguaje utilizado eran apropiados y relevantes para el tema. Otras cinco enfermeras consideraron que la calidad de la técnica audiovisual utilizada, el ambiente simulado, la caracterización de los personajes y el desarrollo de las estrategias de comunicación enfermero-paciente estaban presentes y eran adecuados. La versión final del video fue evaluada por nueve estudiantes de enfermería que tuvieron un nivel de comprensión de los ítems igual o superior al 96%. El video presenta las siguientes estrategias: Estrategias Generales de Comunicación, Comunicación Intercultural, NURSE, Tell me more, Ask-Tell-Ask, Comunicación Terapéutica y Comunicación de Malas Noticias. Conclusión: este estudio describe la creación de un video, la validación que realizaron del mismo los expertos y la evaluación del público objetivo, quienes consideraron que es un recurso educativo importante para el proceso de enseñanza-aprendizaje de las estrategias de comunicación. Los jueces y el público objetivo consideraron que el video era un instrumento válido para enseñar las estrategias de comunicación enfermero-paciente.

Objective: to create, validate and evaluate an educational video on nurse-patient communication strategies for undergraduate Nursing students. Method: this is a methodological study with a longitudinal design and quantitative analysis. The following stages were conducted: pre-production, production, post-production and evaluation of the video by the target population. Results: five female nurses evaluated the video storyboard and indicated understanding of the subject matter, the topics addressed and the language used as adequate and pertinent to the theme. Another five female nurses considered the following as present and desirable elements: quality of the audiovisual technique employed, simulated environment, characterization of the characters, and development of the nurse-patient communication strategies The final version of the video was evaluated by nine Nursing students that presented a level of item understanding of at least 96%. The video presents the following strategies: General communication strategies, Intercultural Communication, NURSE, Tell me more, Ask-Tell-Ask, Therapeutic Communication and Communicating Bad News. Conclusion: this study portrays the creation of a video, its validation by experts and its evaluation by the target population, which indicated it as a relevant educational resource for the teaching-learning process regarding communication strategies. Both the evaluators and the target population considered that the video is a valid instrument to teach content about the nurse-patient communication strategies.

Objetivo: construir, validar e avaliar um vídeo educativo sobre estratégias de comunicação enfermeiro-paciente para estudantes da graduação em enfermagem. Método: trata-se de um estudo metodológico, com delineamento longitudinal e análise quantitativa. Foram percorridas as etapas de pré-produção, produção, pós-produção e avaliação do vídeo pelo público-alvo. Resultados: cinco enfermeiras avaliaram o storyboard do vídeo e apontaram a compreensão do tema, os tópicos abordados e a linguagem utilizada como adequadas e pertinentes à temática. Outras cinco enfermeiras consideraram presentes e desejáveis: qualidade da técnica audiovisual empregada, ambiente simulado, caracterização das personagens e desenvolvimento das estratégias de comunicação enfermeiro-paciente. A versão final do vídeo foi avaliada por nove estudantes de enfermagem que apresentaram nível de compreensão dos itens igual ou acima de 96%. O vídeo apresenta as seguintes estratégias: Estratégias gerais de comunicação, Comunicação Intercultural, NURSE, Tell me more, Ask-Tell-Ask, Comunicação Terapêutica e Comunicação de Más Notícias. Conclusão: este estudo retrata a criação de um vídeo, sua validação por peritos e sua avaliação pelo público-alvo, que manifestaram tratar-se de um recurso educativo relevante para o processo de ensino-aprendizagem de estratégias de comunicação. Os juízes e o público alvo consideraram o vídeo como um instrumento válido para ensinar sobre as estratégias de comunicação enfermeiro-paciente.

Resilience in Older People: A Concept Analysis.

(1) Background: Resilience has been presented as a potential protective factor to be promoted in difficult experiences in older people. However, further clarification of the concept of resilience for this population is required, as this is of critical interest for nursing care. (2) Aim: To develop the concept of resilience in older people to establish the elements that refer to the nursing outcome. Personal resilience (1309) from the Nursing Outcomes Classification (NOC), specifically in older people. (3) Methods: Concept analysis using Beth Rodgers' evolutionary model. The attributes, antecedents, consequents, and empirical elements were described in the integrative review, with searches in PubMed, CINAHL, PsycINFO, LILACS, and Embase databases. A total of 2431 citations have been identified, and 110 studies were included. (4) Results: The concept of "resilience in older people" is composed of two attributes, available resources and positive behaviors, and is defined as positive attitudes of older people with the assistance of resources available from experiences of adversity. Conclusion: This analysis and concept development of resilience in older people provided sensitive indicators for nursing care in the context of adversity, considering available resources and with positive attitudes during this phase of life span.

Nurse-patient communication strategies: A proposal of an educational video for Nursing students. / Estrategias de comunicación enfermero-paciente: propuesta de un video educativo para estudiantes de enfermería.

OBJECTIVE: to create, validate and evaluate an educational video on nurse-patient communication strategies for undergraduate Nursing students. METHOD: this is a methodological study with a longitudinal design and quantitative analysis. The following stages were conducted: pre-production, production, post-production and evaluation of the video by the target population. RESULTS: five female nurses evaluated the video storyboard and indicated understanding of the subject matter, the topics addressed and the language used as adequate and pertinent to the theme. Another five female nurses considered the following as present and desirable elements: quality of the audiovisual technique employed, simulated environment, characterization of the characters, and development of the nurse-patient communication strategies The final version of the video was evaluated by nine Nursing students that presented a level of item understanding of at least 96%. The video presents the following strategies: General communication strategies, Intercultural Communication, NURSE, Tell me more, Ask-Tell-Ask, Therapeutic Communication and Communicating Bad News. CONCLUSION: this study portrays the creation of a video, its validation by experts and its evaluation by the target population, which indicated it as a relevant educational resource for the teaching-learning process regarding communication strategies. Both the evaluators and the target population considered that the video is a valid instrument to teach content about the nurse-patient communication strategies.

Topical formulation containing chitosan-chamomile microparticles in cutaneous wound healing in rats.

Objective: The aim of this research was to evaluate the efficacy of a topical formulation containing chitosan-chamomile microparticles in cutaneous healing in rats. Method: Male Wistar rats (n=57) were randomly distributed into three groups: treatment; vehicle; and control. Evaluations were performed on days 2, 7 and 14 after the surgical procedure using skin lesion photography, and histological and biochemical analyses. Results: The results showed that there was no difference in the healing index and in the histological analysis of the inflammatory infiltrate among groups. Fibrogenesis was more significant in the group treated with the test formulation at day 7, and angiogenesis was greater in the vehicle and chamomile groups at day 2. The quantification of hydroxyproline showed a higher amount of collagen in the group treated with chamomile, mainly at day 14, although the histological quantification of collagen showed no difference between the groups. Conclusion: From the results of this study, it can be concluded that the formulation, although it had no effect on the healing time, improved the quality of the cicatricial tissue formed with a greater quantity of fibroblasts and collagen.

Adaptación cultural y equivalencia semántica de la Incivility in Nursing Education Revised Survey: versión brasileña / Adaptação cultural e equivalência semântica do incivility in nursing education - revised survey: versão brasileira / Cultural adaptation and semantic evaluation of incivility in nursing education - revised survey: brazilian version

RESUMO Objetivo: realizar a adaptação cultural e a equivalência semântica do Incivility in Nursing Education - Revised Survey para a cultura brasileira. Método: pesquisa metodológica realizada em uma escola paulista de enfermagem e que contou com as seguintes etapas: tradução, síntese das traduções, retrotradução, análise por comitê de especialistas, teste na população-alvo e apresentação da versão final à autora. A avaliação semântica para o idioma português do Brasil com a população-alvo seguiu o método DISABKIDS®. Resultados: obteve-se uma versão traduzida com poucas divergências da versão original. A equivalência semântica apontou poucos itens de dificuldade, e as sugestões dos 21 estudantes de enfermagem que participaram dessa etapa foram essenciais para ajustes em três itens. A versão brasileira é composta por 24 itens referentes a comportamentos de estudantes e outros 24 a comportamentos de professores, representando os níveis alto e baixo de incivilidade. A versão final também conta com questões de múltipla escolha e questões descritivas para caracterizar o fenômeno na instituição e propor alternativas de enfrentá-lo. Esta versão apresenta grande similaridade à versão original e foi aprovada pela autora original. Conclusão: a adaptação à cultura brasileira e a equivalência semântica foram concluídas satisfatoriamente, resultando numa versão com condições de ser submetida à análise de propriedades psicométricas e contribuir para identificação e manejo do fenômeno incivilidade nas instituições brasileiras de ensino de Enfermagem.

RESUMEN Objetivo: el propósito es llevar a cabo la adaptación cultural y la equivalencia semántica de la Incivility in Nursing Education - Revised Survey para que sea aplicable a la cultura brasileña. Método: se llevó a cabo una investigación metodológica en una escuela de enfermería en el estado de São Paulo, que abarcó diversas etapas: traducción, síntesis de traducciones, retrotraducción, análisis por parte de un comité de expertos, prueba en la población objetivo y presentación de la versión final a la autora original. Para evaluar la equivalencia semántica en el idioma portugués de Brasil con la población objetivo, se siguió el método DISABKIDS®. Resultados: se logró obtener una versión traducida con mínimas discrepancias respecto a la versión original; el análisis de equivalencia semántica reveló algunas dificultades en determinados ítems, y las aportaciones de los 21 estudiantes de enfermería que participaron en esta etapa resultaron esenciales para realizar ajustes en tres ítems. La versión brasileña consta de 24 ítems vinculados a comportamientos de estudiantes y otros 24 relacionados con comportamientos de profesores, que representan niveles altos y bajos de incivilidad. Además, se incluyen preguntas de opción múltiple y descripciones para caracterizar el fenómeno en la institución y proponer alternativas para hacer frente a el. Esta versión guarda una notable semejanza con la original y recibió la aprobación de la autora original. Conclusiones: se logró llevar a cabo la adaptación exitosa a la cultura brasileña y la equivalencia semántica, lo que dio lugar a una versión que está lista para someterse a un análisis de propiedades psicométricas y contribuir a la identificación y manejo del fenómeno de la incivilidad en las instituciones educativas de enfermería en Brasil.

ABSTRACT Objective: to culturally adapt and verify the semantic equivalence of Incivility in Nursing Education - Revised Survey for the Brazilian culture. Method: a methodological study was conducted in a nursing school in São Paulo, Brazil, according to the following steps: translation, reconciled translated version, back-translation, expert committee, test in the target population, and final version was presented to the author of the original version. The semantic assessment of the Brazilian Portuguese with the target population followed the DISABKIDS method®. Results: the translated version presented few divergences from the original one. The semantic equivalence assessment indicated a few problematic items, and the suggestions of 21 nursing students who participated in this stage were essential for adjusting three items. The Brazilian version comprises 24 items concerning the students' behaviors, and another 24 concern the professors' behaviors, representing high and low levels of incivility. The final version also comprises multiple choice questions and descriptive-type questions to characterize the phenomenon at the institution and propose alternatives to deal with it. This version is very similar to the original one and was approved by the original author. Conclusion: the adaptation to the Brazilian culture and semantic evaluation were satisfactorily concluded, resulting in a version that can be submitted to psychometric proprieties and contribute to identifying and managing the incivility phenomenon in Brazilian Nursing institutions.

Prevalence, defining characteristics, and predictors of the nursing diagnosis of spiritual distress in cancer patients undergoing chemotherapy: A longitudinal study.

INTRODUCTION: Cancer patients are exposed to several types of treatments, including chemotherapy. In this context, patients experience several nursing diagnoses, including spiritual distress. The definition of the diagnosis of spiritual distress is grounded in lack of meaning and purpose in life, a sense of suffering, and a feeling of disconnected. PURPOSE: The aim of this study was to determine the prevalence, sensitivity, specificity, and predictors of the nursing diagnosis of spiritual distress of cancer patients undergoing chemotherapy. DESIGNS: The study used a longitudinal questionnaire design with quarterly data collection points over a 12-month period. Participants were recruited through random sampling, in an outpatients' setting in one oncology day unit in Portugal. FINDINGS: The highest prevalence of spiritual distress was found at 3 months after patients started chemotherapy. The highest value of specificity was lack of meaning in life and express suffering, and the highest values of sensitivity concerned spiritual distress diagnosis. The predictors of spiritual distress were express suffering, alienation, questioning meaning in life, lack of serenity, questioning the meaning of suffering, hopelessness, and lack of meaning in life. CONCLUSIONS: Spiritual distress is a human response that is current in patients undergoing chemotherapy, and the highest prevalence seems to occur at 3 months after commencing chemotherapy. Express suffering and lack of meaning in life play the role not only of defining characteristics (DC) in this study, but also of predictors in the diagnosis of spiritual distress. CLINICAL RELEVANCE: The identification of the prevalence, predictors, sensitivity, and specificity of the DC of the nursing diagnosis of spiritual distress in cancer patients undergoing chemotherapy may facilitate nurses' clinical reasoning and improve the planning of nursing care in clinical practice in order to improve spiritual well-being in cancer patients.

A Chitosan-Coated Chamomile Microparticles Formulation to Prevent Radiodermatitis in Breast: A Double-blinded, Controlled, Randomized, Phase II Clinical Trial.

PURPOSE: The aim was to evaluate the effect of a topical formulation containing chitosan-coated Chamomilla recutita (L.) rauschert microparticles regarding the incidence, grade, and days for the appearance of radiodermatitis (RD) in women with breast cancer. METHODS: A double-blinded, controlled, randomized, phase II clinical trial developed with women diagnosed with breast cancer who will receive radiation therapy. The participants were randomly divided into 2 groups: control and treatment. They were followed up until the end of the treatment or the appearance of grade III RD. RESULTS: Fifty-four women were included in the study. There is no significant difference between the groups in the incidence (88.9% vs. 88.9%, P=1.0) or time to develop any grade of RD (3 days of difference, P=0.300). A significant reduction was observed in the incidence (P=0.03) and in the time to appearance (7 d of difference, P=0.01) grade 2 or >RD. In the follow-up evaluation (15 d after the end of treatment), the Chamomile group presented a superior skin recovery than the control group (P=0.0343). High-intensity local symptoms as pain, and pruritus were significantly reduced in the Chamomile group. CONCLUSIONS: Although no effect was observed with chamomile to reduce any grade of RD, it was effective to reduce grade 2 or >toxicity, to improve skin recovery and to diminish high-intensity local symptoms. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC): RBR-9hnftg, April 29, 2019.

HPV-related quality of life in diagnosed women: A longitudinal study.

This paper explored changes in the HPV-related quality of life (QoL) of 209 women diagnosed with human papillomavirus (HPV) during 1 year of medical monitoring, at three time points (6-month interval between them). Participants completed the HPV Impact Profile (HIP) questionnaire to assess HPV-related QoL. The relationship between HIP scores and time was moderated by the HPV risk type and infection duration: an HPV diagnosis had a stronger negative effect on patients with an HPV high-risk type and on those living with HPV for a long period of time. Age, condom use, motherhood, and type of family were significant predictors.

Checklists for Assessing Skills of Children With Type 1 Diabetes on Insulin Injection Technique.

BACKGROUND: School-aged children often participate in type 1 diabetes (T1D) self-care tasks. Despite widespread discussion about the importance of developing self-care skills in childhood, few explain how the health care team should assess the skills of children with T1D when performing insulin injections. OBJECTIVE: We sought to assess content validity evidence in two checklists regarding injection technique performed by children. METHODS: Two checklists were designed based on a systematic review of the insulin injection technique. Experts in pediatric diabetes, health literacy, and diabetes education assessed the checklists regarding their clarity, objectivity, and relevance. Content validity was assessed using the content validity ratio (CVR). RESULTS: Eleven providers (72% nurses or physicians, professional experience 19.4 ± 10.1 years, 45% of specialists in endocrinology, and 18% in pediatrics) participated in the assessment. Experts considered items containing the word homogeneity inappropriate. Items related to the needle insertion angle and the skin fold did not reach the CVR critical value. The final version of the checklist for syringe injection comprised 22 items with CVR = 0.91, and the checklist for pen injection comprised 18 items with CVR = 0.87. CONCLUSIONS: The checklists presented clear, objective, and relevant content that assesses the skills of children with T1D for insulin injection. The checklists formally present the order of the technique and all the steps for insulin injection and allow a quantitative assessment of the operational skills of children. The developed instruments offer providers the possibility of continuous assessment of the progress of the pediatric clientele until they reach independence in diabetes self-care.

Differential validation of nursing diagnoses: An integrative literature review on the use of the method.

PURPOSE: This review aimed to analyze the use of differential validation of nursing diagnosis. METHODS: Integrative literature review with search on international databases. The diagnoses, the type of the diagnosis differential validation, the sample, the method, main results, and the limitations were extracted. Ten studies were included. FINDINGS: Differential diagnostic validation publication dates from 1994, and Brazil was the predominant country. CONCLUSIONS: This method seems helpful in improving diagnosis accuracy, particularly those related to subjective, behavioral, or complex human responses. IMPLICATIONS FOR NURSING PRACTICE: Using this model may facilitate understanding the specificity of nursing diagnosis, which is critical for teaching clinical reasoning and for new opportunities to research.

OBJETIVO: O objetivo desta revisão foi analisar a utilização da validação diferencial de diagnósticos de enfermagem. MÉTODOS: Revisão integrativa da literatura com pesquisa em bases de dados internacionais. Foram extraídos dados referentes ao tipo de diagnóstico, validação diferencial, amostra, metodologia, principais resultados e limitações. Foram incluídos 10 estudos. RESULTADOS: Foram identificadas publicações desde 1994, sendo o Brasil o país predominante. CONCLUSÕES: Este modelo parece ser útil para melhorar a precisão do diagnóstico, particularmente aqueles relacionados a respostas humanas subjetivas, comportamentais ou complexas. IMPLICAÇÕES PARA A PRÁTICA: O uso deste modelo pode facilitar a compreensão da especificidade do diagnóstico de enfermagem, que é fundamental para o ensino do raciocínio clínico, para novas oportunidades de pesquisa.

End-of-life: An urgent update in nursing terminology.

Although nursing terminologies and classifications represent nursing knowledge across diverse clinical areas, end-of-life care seems under represented in many aspects of these instruments. NANDA- I is an international nursing diagnostic classification widely used in nursing education and research. This taxonomy is based on seven axes, including the axis of time. In this commentary we bring discussion to the need to update nursing terminology by including the term end-of-life in the time axis of NANDA-I. After describing the epidemiologic aspects of end-of-life care and discussing the relevant nursing role, we discuss patients' and family's human responses towards the end-of-life time and circumstance, which are central to defining nursing diagnoses. End-of-life care is one priority in health care, and nursing diagnoses should represent that situation as well. This paper focuses on a specific and international nursing diagnosis classification, NANDA-I, which lacks an end-of-life component to its time axis for defining labels of nursing diagnoses. Attending to the importance of classifications in clinical reasoning, nursing diagnoses could better represent responses towards this health condition, opening new opportunities for increasing nursing roles in clinical practice, and also for new studies aiming to validate nursing diagnoses, and promoting an evidence-based practice by including end-of-life in the axis time.

Spiritual Distress in Patients With Cancer Initiating Chemotherapy: A Cross-Sectional Study.

PURPOSE: To assess spiritual distress in patients with cancer who were initiating chemotherapy. METHODS: This was a quantitative, observational, cross-sectional study. Data collection was conducted between February and June of 2019. The Spiritual Distress Scale (SDS) was administered to 332 patients with cancer. FINDINGS: Most participants (56.6%) were female, with the mean age at 60.3 years (SD = ±11.73). The mean SDS score was 56.6 (SD = ±13.39), with 30% of the participants reporting moderate and 9.6% reporting high levels of spiritual distress. Younger age (ß = -0.687, p = .008) and participants having no religious affiliation were predictors of SDS (ß = -8.322, p = .035) in patients with cancer initiating chemotherapy. CONCLUSIONS: Given the degree of spiritual distress reported, this study provides further evidence to support the need for nurses to assess spirituality in order to provide holistic care inclusive of spiritual domain. CLINICAL RELEVANCE: These results are relevant to clinical practice and indicate a need for nurses to use the clinical reasoning process to assess spiritual distress and to plan nursing interventions aimed at meeting the spiritual needs of patients with cancer who are initiating chemotherapy.

Clinical judgment performance of undergraduate Nursing students.

OBJECTIVE: to evaluate the reported performance regarding clinical judgment by undergraduate Nursing students. METHOD: a cross-sectional study with the application of the Lasater Clinical Judgment Rubric-Brazilian Version in 166 undergraduate Nursing students from a Brazilian public university. The data were analyzed descriptively and analytically (by comparing the level of clinical judgment among students from the initial, intermediate, and concluding groups). The following tests were applied: Chi-square, Fisher's Exact and Kruskal-Wallis, and a p-value of 0.05 was adopted. The reliability of the global instrument (Cronbach's alpha) was 0.786. RESULTS: of the 166 students, 65.7% evaluated themselves as proficient in relation to the reported performance on clinical judgment. Of the rubric's 11 dimensions (focused observation, recognizing deviations from expected patterns, information seeking, prioritizing data, making sense of data, calm and confident manner, clear communication, well-planned intervention/flexibility, being skillful, evaluation/self-analysis, and commitment to improvement), only four groups did not present significant differences among them (p<0.05): focused observation, information seeking, prioritizing data, and calm and confident manner. CONCLUSION: the performance on clinical judgment reported as proficient was pointed out by 65.7% of the students and a significant statistical difference was verified in seven dimensions, among beginners, intermediate, and concluding students, compatible with the evolution of learning.

Contribution of an instructional module for lymph node evaluation: An experiment.

OBJECTIVE: to evaluate the contribution of an instructional module identifying the number and characteristics of lymph nodes by undergraduate nursing students. METHOD: an experimental, randomized, controlled and masked study using an instructional module for intervention. The 68 students who made up the control group or the experimental group performed the prototype lymph node palpation in the initial and final phases, following the free registration of the characteristics and number of these structures. Between the phases, the instructional module (palpation prototype and a registration guide instrument) was applied to the experimental group. Descriptive statistics and mixed linear regression were used for analysis. RESULTS: the experimental group showed greater accuracy (p<0.05) in the evaluation of the size, consistency, mobility and coalescence of the lymph nodes in the final phase when compared to the control; it also showed more chances to correctly evaluate the consistency ( OR 45,26; 95% CI<7,74>‡<264.54> p<0.0001), mobility (OR 55.95; CI 95% 12.45 - 251.60; p<0.0001) and size (OR 25.64; CI 95% 3.92 - 160.2; p=0.0002) of the lymph nodes. CONCLUSION: the results reinforce the contribution of the instructional module to increase the knowledge of nursing students about the evaluation of lymph nodes.

Therapeutic play to teach children with type 1 diabetes insulin self-injection: A pilot trial in a developing country.

PURPOSE: Child participation in type 1 diabetes (T1D) self-care is needed in developing countries due to a lack of resources, especially during the school day. This pilot study evaluated the feasibility of a therapeutic play intervention (ITP) versus standard education (SE) on the ability of children with T1D to correctly perform insulin injection technique. DESIGN AND METHODS: Children with T1D (7-12 years) were recruited at two diabetes clinics in Brazil and randomized to ITP or SE. Registered nurses received protocol training to deliver the intervention and perform data collection. ITP group received an education that included a story about a child with T1D who self-injects insulin at school; SE group received routine clinic-based education. Preintervention, children were video-recorded giving insulin injections to a doll; postintervention, children were rerecorded giving the doll an injection. The research team reviewed the videos and assessed the injection technique using validated checklists. Parents reported children's self-injection practices at baseline and 30 days. RESULTS: Children (N = 20, 40% male) were 9.6 ± 1.3 years old and had T1D for 3.6 ± 2.3 years; HbA1c was 9.1 ± 2.0%; 20% of ITP and 50% of SE children used syringes (vs. pens) for injections. At baseline, 80% of both groups knew how to self-inject; most were taught by a parent/relative. Injection technique scores were low in both groups; ITP group increased their scores significantly postintervention. Practices of self-injection did not change in either group after 30 days. PRACTICE IMPLICATIONS: The play-based intervention appeared to improve the injection technique in the short-term. Pilot findings support the development of a larger trial to evaluate the effectiveness of ITP on educating children on insulin injections.

Estilo de aprendizagem e grau de satisfação em simulação clínica em enfermagem / Estilo de aprendizaje y nivel de satisfacción en simulación clínica en enfermería / Learning style and level of satisfaction in nursing clinical simulation

Resumo Objetivo Analisar as relações entre os estilos de aprendizagem de estudantes de enfermagem e o grau de satisfação com experiências clínicas simuladas. Métodos Estudo descritivo, realizado com estudantes de graduação em Enfermagem (n=46) de uma instituição pública do Estado de São Paulo, Brasil, em fevereiro e março de 2018, após aprovação pelo Comitê de Ética em Pesquisa da Instituição. Cada estudante, individualmente, respondeu ao instrumento de identificação, ao Novo Índice de Estilos de Aprendizagem e à Escala de Satisfação com as Experiências Clínicas Simuladas. Foram avaliados os escores médios das distintas dimensões dos instrumentos, bem como, as diferenças entre os escores médios das dimensões de satisfação em relação aos dos estilos de aprendizagem. Resultados Os estilos de aprendizagem variaram, prevalecendo os estilos sensorial e sequencial. Foi elevado o grau de satisfação com a simulação clínica independentemente do estilo de aprendizagem. Houve diferença (p<0,05) ao se relacionar os escores médios da satisfação com simulação e alguns estilos de aprendizagem. Estudantes com os estilos de aprendizagem visual ou verbal apresentaram diferença nas dimensões prática, cognitiva e o total da escala, indicando satisfação com as experiências clínicas simuladas em sua totalidade; já os que possuem os estilos ativo ou reflexivo, a diferença foi apresentada somente na dimensão prática envolvendo simulação. Conclusão Os resultados obtidos evidenciam diferenças na satisfação em simulação a depender do estilo de aprendizagem; reforçam a necessidade de reflexão sobre potencialidades ou dificuldades envolvendo o uso da simulação clínica pelos estudantes de enfermagem.

Resumen Objetivo Analizar la relación entre los estilos de aprendizaje y el nivel de satisfacción respecto a las experiencias clínicas simuladas de estudiantes de enfermería. Métodos Estudio descriptivo, realizado con estudiantes universitarios de enfermería (n=46) de una institución pública del estado de São Paulo, en febrero y marzo de 2018, luego de su aprobación por el Comité de Ética de Investigación de la institución. Cada estudiante respondió de forma individual el instrumento de identificación, el Nuevo Índice de Estilos de Aprendizaje y el Índice de Satisfacción sobre Experiencias Clínicas Simuladas. Se evaluaron las puntuaciones promedio de las distintas dimensiones de los instrumentos, así como las diferencias entre la puntuación promedio de las dimensiones de satisfacción con relación a los estilos de aprendizaje. Resultados Los estilos de aprendizaje son variados, con una prevalencia del estilo sensorial y secuencial. El nivel de satisfacción respecto a la simulación clínica fue elevado, independientemente del estilo de aprendizaje. Se observó una diferencia (p<0,05) al relacionar la puntuación promedio de la satisfacción de simulación con algunos estilos de aprendizaje. Los estudiantes con estilo de aprendizaje visual o verbal presentaron diferencias en la dimensión práctica, cognitiva y el total del índice, lo que indica satisfacción respecto a las experiencias clínicas simuladas en su totalidad. Por otro lado, en los que tenían estilo activo o reflexivo, las diferencias se presentaron solo en la dimensión práctica que incluye simulación. Conclusión Los resultados obtenidos evidencian diferencias en la satisfacción de la simulación dependiendo del estilo de aprendizaje y refuerzan la necesidad de reflexionar sobre las posibilidades o dificultades en torno al uso de la simulación clínica por parte de los estudiantes de enfermería.

Abstract Objective To analyze the relationships between the learning styles of nursing students and the degree of satisfaction with simulated clinical experiences. Methods Descriptive study, carried out with undergraduate nursing students (n=46) from a public institution in Sao Paulo, Brazil, in February and March 2018, after approval by the Institution Research Ethics Committee. Each student individually responded to the identification instrument, the New Learning Styles Index and the Escala de Satisfação com as Experiências Clínicas Simuladas. The average scores of the different dimensions of the instruments were evaluated, as well as the differences among the average scores of the satisfaction dimensions in relation to those of the learning styles. Results Learning styles varied, with sensory and sequential styles prevailing. The degree of satisfaction with the clinical simulation was high regardless of the learning style. There was a difference (p<0.05) when relating the average satisfaction scores with simulation and some learning styles. Students with visual or verbal learning styles showed differences in the practical, cognitive dimensions and the total scale, indicating satisfaction with the simulated clinical experiences; whereas those with active or reflective styles, the difference was presented only in the practical dimension involving simulation. Conclusion The results obtained show differences in satisfaction in simulation depending on the learning style; reinforce the need for reflection on potentialities or difficulties involving the use of clinical simulation by nursing students.

Clinical judgment performance of undergraduate Nursing students / Desempenho do julgamento clínico de estudantes de graduação em Enfermagem / Capacidad de juicio clínico de estudiantes de licenciatura en enfermería

Objective: to evaluate the reported performance regarding clinical judgment by undergraduate Nursing students. Method: a cross-sectional study with the application of the Lasater Clinical Judgment Rubric-Brazilian Version in 166 undergraduate Nursing students from a Brazilian public university. The data were analyzed descriptively and analytically (by comparing the level of clinical judgment among students from the initial, intermediate, and concluding groups). The following tests were applied: Chi-square, Fisher's Exact and Kruskal-Wallis, and a p-value of 0.05 was adopted. The reliability of the global instrument (Cronbach's alpha) was 0.786. Results: of the 166 students, 65.7% evaluated themselves as proficient in relation to the reported performance on clinical judgment. Of the rubric's 11 dimensions (focused observation, recognizing deviations from expected patterns, information seeking, prioritizing data, making sense of data, calm and confident manner, clear communication, well-planned intervention/flexibility, being skillful, evaluation/self-analysis, and commitment to improvement), only four groups did not present significant differences among them (p<0.05): focused observation, information seeking, prioritizing data, and calm and confident manner. Conclusion: the performance on clinical judgment reported as proficient was pointed out by 65.7% of the students and a significant statistical difference was verified in seven dimensions, among beginners, intermediate, and concluding students, compatible with the evolution of learning.

Objetivo: avaliar o desempenho referido sobre julgamento clínico por estudantes de graduação em enfermagem. Método: estudo transversal, com a aplicação da Lasater Clinical Judgment Rubric-Brazilian Version em 166 estudantes da graduação em enfermagem de uma universidade pública do Brasil. Os dados foram analisados de forma descritiva e analítica (comparando o nível de julgamento clínico entre estudantes dos grupos iniciante, intermediário e concluinte). Aplicaram-se os testes: Qui-quadrado, Exato de Fisher e Kruskal-Wallis, e adotou-se p-valor 0,05. A confiabilidade do instrumento global (alpha de Cronbach) foi de 0,786. Resultados: dos 166 estudantes, 65,7% se avaliaram como proficientes em relação ao desempenho referido sobre julgamento clínico. Das 11 dimensões da rubrica (observação focada, reconhecimento de desvios dos padrões esperados, busca por informações, priorização dos dados, compreensão dos dados, atuação calma e confiante, comunicação clara, intervenção bem planejada/flexibilidade, habilidade técnica, avaliação/autoanálise e comprometimento com o aperfeiçoamento), apenas quatro não apresentaram diferenças significativas entre os grupos (p<0,05): observação focada, busca por informações, priorização dos dados, atuação calma e confiante. Conclusão: O desempenho referido sobre julgamento clínico como proficiente foi apontado por 65,7% estudantes e foi verificada diferença estatística significante, em sete dimensões, entre os iniciantes, intermediários e concluintes, compatível com a evolução da aprendizagem.

Objetivo: evaluar la capacidad referida de juicio clínico de estudiantes de licenciatura en enfermería. Método: estudio transversal con aplicación de la Lasater Clinical Judgment Rubric-Brazilian Version en 166 estudiantes de licenciatura en enfermería de una universidad pública de Brasil. Los datos se analizaron de forma descriptiva y analítica (comparando el nivel de juicio clínico entre los estudiantes de los grupos principiante, intermedio y avanzado). Se aplicaron las pruebas: Chi-cuadrado, Exacta de Fisher y Kruskal-Wallis, y se adoptó un p-valor de 0,05. La confiabilidad del instrumento global (alfa de Cronbach) fue de 0,786. Resultados: de los 166 estudiantes, el 65,7% se evaluó como competente en relación con la capacidad referida de juicio clínico. De las 11 dimensiones de la rúbrica (observación enfocada, reconocimiento de desviaciones de los estándares esperados, búsqueda de información, priorización de datos, comprensión de datos, desempeño tranquilo y seguro, comunicación clara, intervención bien planificada/flexibilidad, habilidad técnica, evaluación/autoanálisis y compromiso con la mejora), solo cuatro no mostraron diferencias significativas entre grupos (p<0,05): observación enfocada, búsqueda de información, priorización de datos, desempeño tranquilo y seguro. Conclusión: el 65,7% de los estudiantes consideró que poseía juicio clínico competente y hubo una diferencia estadísticamente significativa, en siete dimensiones, entre principiantes, intermedios y avanzados, compatible con la evolución del aprendizaje.

Strategies to educate young people with type 1 diabetes mellitus on insulin therapy: systematic review / Estrategias para educar a los jóvenes con diabetes melitus tipo 1 sobre la insulinoterapia: una revisión sistemática / Estratégias para educar jovens com diabetes mellitus tipo 1 sobre insulinoterapia: revisão sistemática

ABSTRACT Objective: to identify evidence available in the literature on educational strategies used in the teaching of insulin therapy to children and adolescents with Type 1 diabetes mellitus. Method: systematic review undertaken in five databases, using the descriptors Insulin/therapeutic use, Patient education as topic, Diabetes mellitus type 1, Child, Infant, Adolescent and keywords, without any time limit. Primary studies on insulin therapy teaching were included, while research on insulin pumps was excluded. Results: 243 studies were identified, 13 of which were included. The results present educational strategies focused on children, adolescents and young people of up to 24 years of age, applied individually or in groups; by telephone contact or text messages by mobile phone; dramatization and educational camps; by a single professional or a multidisciplinary team. The strategies described in the analyzed studies addressed the adjustment of insulin dosages in everyday situations and education for insulin management, associated with the nutritional strategy of carbohydrate counting, diabetes education with a specific module on insulin therapy and intensive insulin use. The studies analyzed the effect of the educational intervention on several clinical and behavioral outcomes, such as glycated hemoglobin and self-efficacy. Conclusion: this review could not identify a single educational strategy able to improve metabolic and psychosocial outcomes. In most cases, nurses are the professionals responsible for the development of educational strategies focused on insulin therapy in children and adolescents with diabetes, regardless of the context in which they will be deployed. This confirms their role as educators.

RESUMEN Objetivo: identificar la evidencia disponible en la literatura sobre las estrategias educativas utilizadas para enseñar la terapia con insulina a niños y adolescentes con diabetes mellitus tipo 1. Método: revisión sistemática, realizada en cinco bases de datos, con los descriptores Insulina / uso terapéutico, Educación del paciente como tema, Diabetes mellitus tipo 1, Niño, Lactante, Adolescente y palabras clave, sin delimitación de períodos. Se incluyeron estudios primarios sobre la enseñanza de la terapia con insulina y se excluyó la investigación sobre la bomba de insulina. Resultados: se identificaron 243 estudios, de los cuales se incluyeron 13. Los resultados presentan estrategias educativas dirigidas a niños, adolescentes y jóvenes hasta los 24 años, aplicadas individualmente o en grupos; por contacto telefónico o mensajes de texto por teléfono celular; juegos de rol y campamentos educativos; por un solo equipo profesional o multidisciplinar. Las estrategias descritas en los estudios analizados abordaron el ajuste de la insulina en situaciones cotidianas y la educación para el manejo de la insulina, asociadas a la estrategia nutricional de conteo de carbohidratos, educación en diabetes con módulo específico sobre terapia insulínica y uso intensivo de insulina. Los estudios analizaron el efecto de la intervención educativa sobre varios resultados clínicos y conductuales, como la hemoglobina glucosilada y la autoeficacia. Conclusión: no fue posible determinar una única estrategia sobre la terapia con insulina capaz de mejorar el control metabólico y psicosocial. El desarrollo de estrategias educativas orientadas a la terapia con insulina para niños y adolescentes con diabetes, independientemente del contexto en el que se implementen, tiene, en su mayor parte, al enfermero como profesional responsable, lo que reafirma su rol educativo.

RESUMO Objetivo: identificar evidências disponíveis na literatura sobre estratégias educativas utilizadas no ensino da insulinoterapia às crianças e adolescentes com diabetes mellitus tipo 1. Método: revisão sistemática, realizada em cinco bases de dados, com os descritores Insulin/therapeutic use, Patient education as topic, Diabetes mellitus type 1, Child, Infant, Adolescent e palavras-chave, sem delimitação de período. Incluídos estudos primários acerca do ensino da insulinoterapia e excluídas pesquisas sobre bomba de insulina. Resultados: identificados 243 estudos, dos quais foram incluídos 13. Os resultados apresentam estratégias educativas direcionadas às crianças, adolescentes e jovens de até 24 anos de idade, aplicadas de forma individual ou em grupos; por contato telefônico ou mensagens de texto por celular; dramatização e acampamentos educativos; por um único profissional ou equipe multidisciplinar. As estratégias descritas nos estudos analisados abordaram ajuste da insulina em situações cotidianas e educação para manejo da insulina, associados com a estratégia nutricional de contagem de carboidratos, educação em diabetes com módulo específico sobre insulinoterapia e uso da insulina de forma intensiva. Os estudos analisaram o efeito da intervenção educativa sobre diversos desfechos clínicos e comportamentais, como a hemoglobina glicada e autoeficácia. Conclusão: não foi possível determinar uma única estratégia sobre a insulinoterapia capaz de melhorar o controle metabólico e psicossocial. O desenvolvimento de estratégias educativas voltadas à insulinoterapia de crianças e adolescentes com diabetes, independentemente do contexto em que serão implementadas, tem, em sua maioria, o enfermeiro como profissional responsável, o que reafirma seu papel educador.